Wednesday, June 1, 2011

Establishing Nevada's Exchange

One of the challenges for states is for states to establish their “State Health Insurance Exchange”. Nevada has been discussing whether states should currently plan and develop their own exchanges by 2014 or choose to opt-in to an Exchange operated by the Federal government for the state.

If the state operates its own Exchange, consumers and employers can feel a greater sense of ownership. Nevada is in agreement and eager to plan, develop, and operate their own Health Insurance Exchange as the state sees advantages such as.

• The state’s ability to maintain regulatory authority over a large share of the commercial health insurance market
• The state’s own exchange would help mitigate risk selection that may result from different rating and underwriting rules for insurance policies sold inside and outside the Exchange
• Providing for greater coordination of benefits and eligibility rules across health coverage programs such as Medicaid, CHIP, and policies sold through the Exchange
• Being able to promote state health reform strategies and priorities through the Exchange

The state has been working with Public Consulting Group, Inc to develop the key information needed to identify data sources, find ways to collect the data, and examine the best methods to use to analyze the collected data. They are also developing demographic profiles to prepare summary reports on the uninsured in the state, on the commercial insurance market in the state, and working to collect data on Medicaid, CHIP, and county-based medical assistance programs.

Information technology resources will play an important role in developing the Health Insurance Exchange. Since, most of Nevada’s current IT systems use outdated, hotlines and web sites, this means that the systems will need to be updated and modified.

One of the biggest problems the state faces is that currently there are two separate and distinct eligibility processes for the state’s Medicaid and CHIP programs administered by two different agencies. In order to establish a single portal, the state will have to modify their existing eligibility system or develop a new eligibility system in order to process applications and be able to determine eligibility for all medical assistance programs.

A committee discussing Medicaid and Medicare issues has documented several changes that will need to be phased in over the next six years. They have reviewed the mandatory and optional Medicaid provisions to determine which provisions will need to be implemented and when. The committee along with key finance staffers has developed projections detailing the future expansion of the Medicaid caseload.

The state needs to complete a “Planning Advanced Planning Document”, a feasibility study, and an “Implementation Advanced Planning Document” plus a Request for Proposal (RFP) will need to be issued. The development of the documents is important so that the state can secure funding and by issuing the RFP, vendors will be able to design, develop, and implement the eligibility engine.

So far, several state activities are ongoing. The project to plan, design, and build the eligibility engine is underway and key IT staff from the Department of Welfare and Supportive Services as well as staff from Medicaid along with consultants are preparing the feasibility study.

Right now, work has begun on a Request for Information (RFI) document to solicit responses from potential vendors. Specifically, the project is going to need vendors to provide information on services related to development of the web portal, requirements for eligibility processing, verification, enrollment, plus be involved with other business activities.

The state wants to learn from other states and their experiences and want to share best practices. It has been suggested that it would be a good idea to establish a regular forum where specific issues could be discussed to effectively share knowledge.

Recently, legislation (SB440) was introduced in the state to establish the “Silver State Health Insurance Exchange”. According to the legislation, the Exchange would be an independent public entity to be housed within its own governmental agency. The legislation creates the administrative structure and authorizes a seven member board to perform the duties and powers necessary to develop the operations of the Exchange. This board would adopt bylaws, create procedures, adopt regulations, hire staff, contract for professional services, and prepare a report to go to the Governor, legislature, and the public.